OBJECTIVE: To identify common character stereotypes of alcohol and other drug users as portrayed in motion pictures.
METHOD: A selective review of a number of movies prominently portraying alcohol and other drug use and misuse.
FINDINGS: The great majority of popular films portray alcohol and drug use whether as a routinized background, routinized foreground or exceptional foreground. Four main stereotypes of alcohol and other drug users appear to be prevalent - the tragic hero, the demonized user, the rebellious free spirit and the comedic user. A number of movies are selected which portray alcohol and other drug use as a prominent theme.
DISCUSSION: Movies, as a medium for mass communication, have a powerful influence on the public and perpetuate popular mythologies regarding alcohol and other drug use.
Measuring public opinion on alcohol policy. A factor analytic study of a US probability sample.
Correspondence: William W. Latimer, Department of Mental Hygiene, School of Hygiene and Public Health, Johns Hopkins University, 850 Hampton House, 624 North Broadway, 21205, Baltimore, MD, USA; (email: wlatimer@jhsph.edu).
Public opinion has been one factor affecting change in policies designed to reduce underage alcohol use. Extant research, however, has been criticized for using single survey items of unknown reliability to define adult attitudes on alcohol policy issues. The present investigation addresses a critical gap in the literature by deriving scales on public attitudes, knowledge, and concerns pertinent to alcohol policies designed to reduce underage drinking using a US probability sample survey of 7021 adults. Five attitudinal scales were derived from exploratory and confirmatory factor analyses addressing policies to: (1) regulate alcohol marketing, (2) regulate alcohol consumption in public places, (3) regulate alcohol distribution, (4) increase alcohol taxes, and (5) regulate youth access. The scales exhibited acceptable psychometric properties and were largely consistent with a rational framework which guided the survey construction.
Sale of alcohol in pharmacies: results and implications of an empirical study.
Alcohol misuse continues to be a major concern in the health care community. Within this community, pharmacists are ideally positioned to play a major role in preventive efforts in dealing with alcohol misuse. The objective of the study was to follow-up on important findings from a 1996 statewide survey of Indiana pharmacists regarding their opinions and practices related to the sale of alcohol in pharmacies. Of the 1,280 registered Indiana pharmacies, one-half were chosen using a systematic random selection process. From the 640 pharmacies contacted, 476 pharmacists responded completely to the questionnaire, providing a 74.4% response rate. Findings reveal that independent pharmacies had significantly reduced their sale of alcohol since 1996 while there was no significant change among retail chain pharmacies. Pharmacies that generated a greater share of their business from prescription drugs were less likely to sell alcohol products. Compared to five years ago, significantly more pharmacists in 2001 believed that pharmacies should not sell alcohol. In addition, more than half of pharmacists who worked in pharmacies that sold alcohol felt it differed from their professional values. Twenty-three percent of pharmacists reported inquiring about their patients' alcohol habits, a significant increase over 1996. More pharmacists thought alcohol was an important contributing factor to morbidity in 2001 compared with 1996. The data also revealed that pharmacists were more likely to ask patients about their alcohol habits if they considered alcohol use to be a more important cause of morbidity.
Strategies for reduction and cessation of alcohol use: adolescent preferences.
- Metrik J, Frissell KC, McCarthy DM, D'Amico EJ, Brown SA. Alcohol Clin Exp Res 2003; 27(1): 74-80.
Correspondence: Sandra A. Brown, University of California, San Diego, 9500 Gilman Dr., Department of Psychology (0109), La Jolla, CA 92093-0109, USA; (email: sanbrown@ucsd.edu).
BACKGROUND: Although the majority of youth and adults resolve alcohol problems without formal treatment, we know little about the strategies used by youth in their efforts to decrease alcohol use. Recent studies have begun to address change efforts that adolescents report being helpful in cutting down or stopping alcohol use. The current study seeks to improve our understanding of adolescent change processes in alcohol use by examining the perceptions of high school students.
METHODS: As part of a secondary alcohol intervention study of high school students (ages 12-18; 51% male), 1069 participants completed an anonymous supplemental questionnaire on change strategies for cutting down and stopping alcohol use. Based on content analysis of youth-generated responses, a classification system consisting of nine broad categories was developed (e.g., informal-interpersonal supports, formal aids, alternative activities). Participant responses were independently coded by two raters trained to criterion. Cases with full agreement ( = 934; 96%) were used for data analyses of methods for cutting down drinking, stopping drinking, and strategies recommended for a friend.
FINDINGS: The five most frequently youth-generated change strategies to alter drinking were environmental exposure management (e.g., avoid drinking situations, 19%); informal interpersonal supports (e.g., talk to a friend, 18%); formal aids (e.g., peer support group, counselor, 17%); behavioral self-management (e.g., limit consumption, 14%); and alternative activities (e.g., recreation, sports, 10%). Whereas informal interpersonal supports were consistently endorsed for all change situations, behavioral self-management strategies were viewed as more useful for reduction of drinking and formal aids more critical for cessation efforts. Some differences were observed in youth-generated strategies for changing their own drinking compared with efforts to help friends, with environmental changes (e.g., reducing exposure to risk situations and people, formal aids) more often considered when changing youth's own behavior, and strategies reflecting a need for personal change (e.g., education) recommended to others.
DISCUSSION: Our findings support theoretical conceptualizations of alcohol and drug problem resolution that accommodates multiple pathways to recovery. The normative information about specific change strategies generated by youth may further aid in the design of interventions more acceptable for adolescents.
BACKGROUND: Because of growing concerns of terrorist attacks using chemical, biological, radiological, and nuclear weapons, appropriate diagnosis and management of ocular and systemic effects are important issues for eye care practitioners.
OVERVIEW: The literature on the ocular and systemic effects of chemical, biological, radiological, and nuclear weapons is reviewed to provide practicing optometrists with an overview of the issues involved in incident management. A discussion of the public health issues and implications is also presented. Chemical, biological, radiological, and nuclear weapons can exert serious consequences on the eye and the entire body. Acts of terrorism can pose unique challenges to patient care and to the health care system infrastructure. The clinician must be familiar with signs of potential terrorist activities to aid in appropriate patient care and in the containment of illness in the community.
DISCUSSION: Knowledge of the signs and symptoms of exposure to potential agents used by terrorists and a review of the public health concerns of managing terrorist events can provide the necessary background to help the eye care provider make the appropriate diagnosis and understand the role of the clinician in the hierarchy of disaster preparedness, surveillance, and response.
Correspondence: John C. Davies, Computing Services Department, University of Liverpool, PO Box 147, Liverpool L69 3BX, UK; (email: j.c.davies@liv.ac.uk).
The aim of this study was to investigate the effects of gender and age in the population of patients attending hospital as a result of 'underfoot' accidents. Patients attending hospital for the diagnosis and treatment of injuries were interviewed using a portable computer-based questionnaire, the Merseyside Accident Information Model (MAIM). Two studies were used, based on 2516 (1555 men and 961 women) and 1306 (751 men and 575 women) patients, interviewed while attending A & E, orthopedic wards and fracture clinics in a large teaching hospital. The age range of patients in both studies was 15-90 years. The philosophy underlying MAIM is to record all the available information about the immediate circumstances of the accident. This allows us to identify (1) sources of injuries and (2) incidence of injuries associated with these variables: age, gender and underfoot events (classified by slips, trips, missed footing, turned ankle, unintended step on and loss of balance as the first unexpected event). Even though the criteria for patient selection differed in the two studies, the analysis of both revealed similar characteristics. In both studies, logistic regression analysis showed underfoot accidents were predicted by (1) gender (odds ratios 1.85 and 2.83) and (2) age (odds ratios 1.30 and 1.22) per 10 year increase (all P < 0.001). An increasing fraction of underfoot accidents (odds ratios 1.88 and 2.71) studied produce fractures as the age of the patient increases (odds ratios 1.12 and 1.21; all P<0.001). Patients suffering underfoot accidents are increasingly likely to be female as their age increases. This is true both for 'fracture' and 'non-fracture' accidents, and in the latter at least this cannot be due to osteoporosis. We conclude that older people are increasingly likely to suffer fractures in underfoot accidents. Women are more likely to have underfoot accidents, increasingly with advancing age, and this cannot be explained by gender and ageing effects associated with fractures. We believe these data are potentially important for cost-effective targeting of preventative measures.
OBJECTIVES: Increasing investigation of the visual elements of safe driving environments may be of great benefit to society. Visual disability appears to be only one of many visual factors related to traffic accidents. The purpose of this article was to examine the type of visual impairment mediated by the increased glare sensitivity in adult drivers using the original halometer glare test.
METHODS: In this article, the visual sensory, cognitive and motor functions relevant to driving, their measurement, the epidemiology and prevention of age-associated functional impairments and the relationship of functional impairments to both self-reported driving and the imposition of legal restrictions are reviewed.
FINDINGS: The problem of night and tunnel driving is the most urgent in relation to the effects of glare from vehicle headlights on motion perception of drivers. The reduced mesopic vision and increased sensitivity to glare are accompanied by an increased risk of nighttime accidents. Elderly drivers and patients with beginning cataract cannot sufficiently fulfill the criteria for night driving ability because of contrast and glare sensitivity. It is indispensable for the parameters mentioned to be carefully measured and for drivers to be informed that night driving ability may be impaired, even if visual acuity is sufficient.
DISCUSSION: It would be advisable for traffic safety if simple tests for contrast and glare sensitivity were implemented for vehicles and/or were regularly added to the requirements for a driver's licence, at least for older drivers. The age, functional status and test result limits should be defined to avoid a risk factor in traffic.
The epidemiology of medically attended sport and recreational injuries in Queensland.
- Mummery WK, Schofield G, Spence JC. J Sci Med Sport 2002; 5(4): 307-320.
Correspondence: W. Kerry Mummery, Central Queensland University, School of Health & Human Performance, Building 77 - Room 1.03, Rockhampton, Queensland 4702, AUSTRALIA; (k.mummery@cqu.edu.au).
The Queensland Sport and Recreation Injury Survey (QSRIS) is a retrospective study describing the annual incidence of injuries in the state of Queensland, Australia, resulting from sport and recreational activity involvement. Data were collected by means of a computer-assisted-telephone-interview (CATI) survey of a representative sample of Queenslanders in the spring of 2000. The sample produced a total of 1337 respondents aged 18 to 94 years. The survey asked information regarding medically attended, non-fatal injuries resulting from sport and recreational activities in the past 12 months. Of the 1337 individuals surveyed, 191 of the respondents reported one or more injuries that required medical attention resulting in a total of 222 Injuries. This represents an overall rate of 1,666 medically attended injuries per 10,000 people. Among those reporting a sport or recreational injury, the most common types of injuries were a strained/pulled muscle (30.9%), sprained/torn ligament (24.1%), and fracture (12.6%). The most common bodily locations of injuries were the shoulders (13.0%) and knees (12.5%). Results detail the nature and type of injury, medical professional attending to the injury and the nature of the sport or recreational activity that led to the reported injury, highlighting the number of injuries associated with general fitness activities achieved through high participation rates and low injury rates. This remains an area of much needed attention given the promotional push towards raising the levels of physical activity at a population level.
Correspondence: Hoong Chor Chin, Department of Civil Engineering, The National University of Singapore, 10 Kent Ridge Crescent, 119260, Singapore, SINGAPORE; (email: cvechc@leonis.nus.edu.sg).
Poisson and negative binomial (NB) models have been used to analyze traffic accident occurrence at intersections for several years. There are however, limitations in the use of such models. The Poisson model requires the variance-to-mean ratio of the accident data to be about 1. Both the Poisson and the NB models require the accident data to be uncorrelated in time. Due to unobserved heterogeneity and serial correlation in the accident data, both models seem to be inappropriate. A more suitable alternative is the random effect negative binomial (RENB) model, which by treating the data in a time-series cross-section panel, will be able to deal with the spatial and temporal effects in the data. This paper describes the use of RENB model to identify the elements that affect intersection safety. To establish the suitability of the model, several goodness-of-fit statistics are used. The model is then applied to investigate the relationship between accident occurrence and the geometric, traffic and control characteristics of signalized intersections in Singapore. The results showed that 11 variables significantly affected the safety at the intersections. The total approach volumes, the numbers of phases per cycle, the uncontrolled left-turn lane and the presence of a surveillance camera are among the variables that are the highly significant.
Data fusion, ensemble and clustering to improve the classification accuracy for the severity of road traffic accidents in Korea
Correspondence: So Young Sohn, Department of Computer Science and Industrial Systems Engineering, Yonsei University, 134 Shinchon-dong, Sudaemon-ku, Seoul, SOUTH KOREA; (email: sohns@yonsei.ac.kr).
Increasing amount of road traffic in 1990s has drawn much attention in Korea due to its influence on safety problems. Various types of data analyses are done in order to analyze the relationship between the severity of road traffic accident and driving environmental factors based on traffic accident records. Accurate results of such accident data analysis can provide crucial information for road accident prevention policy. In this paper, we use various algorithms to improve the accuracy of individual classifiers for two categories of severity of road traffic accident. Individual classifiers used are neural network and decision tree. Mainly three different approaches are applied: classifier fusion based on the Dempster-Shafer algorithm, the Bayesian procedure and logistic model; data ensemble fusion based on arcing and bagging; and clustering based on the k-means algorithm. Our empirical study results indicate that a clustering based classification algorithm works best for road traffic accident classification in Korea.
Information on women with domestic violence (DV) suggests increased health care utilization across all levels of care and many diagnoses. In the present ancillary study (1997-2002), derived from a large, group-randomized intervention trial we conducted in a staff-model health maintenance organization (HMO) (1995-1998), we examined total and incremental utilization rates, costs, and patterns for women aged >/=18 years with DV identified through the record reviews conducted for the trial. By the choice of comparison groups used, our present aim was to "bracket" any associated increase in utilization. We compared visits and costs of medical-record confirmed cases of DV (n =62) to those for women without evidence of DV in the record (n =2287). These two groups were derived from women making visits for any one of four index reasons (injury, chronic pelvic pain, depression, or physical examination) associated with higher risk of DV or higher likelihood of its discussion. We constructed a second comparison group (n =6032) from the general population of enrolled women. We used the Chronic Disease Score to adjust for comorbidity. After adjusting for comorbidity, we found a 1.6-fold higher rate of all visits (95% confidence interval [CI]=1.4-1.9) and 1.6-fold higher estimated costs (95% CI=1.3-2.0) for abused women compared to non-DV women. The rates were 2.3-fold higher when compared to all enrolled women. Women with medical-record-documented DV demonstrate a pattern of increased utilization and costs across all levels of care and types of diagnoses. We conclude that being a DV case-patient is associated with between 1.6- and 2.3-fold increases in total utilization and costs.
Hopelessness and risk behavior among adolescents living in high-poverty inner-city neighborhoods.
Correspondence: John M. Boland, Institute for Social Science Research, University of Alabama, Box 870216, 35487-0216, Tuscaloosa, AL, USA; (email: jbolland@bama.ua.edu).
Ethnographic literature on inner-city life argues that adolescents react to their uncertain futures by abandoning hope, leading them to engage in high levels of risk behavior. However, few quantitative studies demonstrate this relationship. This study tests this relationship using a survey of 2468 inner-city adolescents, asking them questions about hopelessness, violent and aggressive behavior, substance use, sexual behavior, and accidental injury. Nearly 50% of males and 25% of females had moderate or severe feelings of hopelessness. Moreover, hopelessness predicted of each of the risk behaviors considered. These results suggest that effective prevention and intervention programs aimed at inner-city adolescents should target hopelessness by promoting skills that allow them to overcome the limitations of hopelessness.
Prevalence of substance use among Iranian high school students.
- Ahmadi J, Hasani M. Addict Behav 2003; 28(2): 375-379.
Correspondence: Jamshid Ahmadi, Shiraz University of Medical Sciences, Hafez Hospital, P.O. Box 71345-1416, Shiraz, IRAN; (email unavailable).
OBJECTIVES: This study assessed the rate of substance use among Iranian high school students.
PARTICIPANTS: 397 high school students (200 girls and 197 boys) were selected randomly and were assessed.
MEASUREMENTS: A confidential questionnaire was distributed, completed by the students, and collected in the same sessions in 2000.
FINDINGS: The mean ages for high school girls and boys were 15.85 and 17.28 years, respectively. Of the subjects, 30.23% reported usage of substance(s) once or more sometime during their lives: cigarettes (25.4%), alcohol (9.6%), opium (3.5%), hashish (2.8%), marijuana (1%), heroin (2%), LSD (0.5%), cocaine (1%), and morphine (0.8%). Only 13.86% of the students were currently using substances: cigarettes (8.3%), heroin (1%), morphine (0.3%), alcohol (4.3%), opium (0.8%), LSD (0.3%), cocaine (0.5%), hashish (0.8%), and marijuana (0.8%). Some used or were using more than one substance.
DISCUSSION: Substance use was significantly higher among males than females. Cigarettes, alcohol, and opium were found to be the most prevalent forms of substance use. Seeking pleasure and release of tension were the most common reasons for substance use.
Epidemiology of snakebite in a central region of Brazil.
Correspondence: L.A. Riberio, Departamento de Clinica Medica, Faculdade de Medicina, Universidade Federal de Uberlandia, Av. Para 1720, 38400-902, MG, Uberlandia, BRAZIL; (email: unavailable).
The aim of this article is to acquire knowledge about the aspects of snakebite epidemiology in a central region of Brazil. From 1993 to 1995, 90 cases of Crotalinae (Bothrops and Crotalus genera) and two cases of Micrurus snakebite were attended to in a general hospital. Epidemiological information about 73 out of the 90 Crotalinae victims was prospectively collected from interviews with the patients and/or their companions. Data from medical records were obtained for the 17 remaining cases. The snakes of Bothrops, Crotalus, and Micrurus genera were responsible for 74, 24 and 2% of the accidents, respectively. Most of the Crotalinae accidents occurred from October to March (68%) and from 06:00 to 12:00 a.m. (93%). Males (89%) and patients between 20 and 30 years-old (27%) were the most common victims. The main bite sites were: foot (24%), leg (23%), hand (22%) and ankle (21%). Among the 73 interviewed Crotalinae victims, farm workers were bitten more frequently (53%). The accidents often occurred during work (59%), and 90% of the patients wore footwear, but 30% were wearing only sandals. Tourniquet, squeezing, suction of the bite site and magic blessing were attempted in 47, 38, 8 and 10% of cases, respectively.
Correspondence: Nelson Adekoya, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Acute Care, Rehabilitation Research, and Disability Prevention, 4770 Buford Highway, NE, MS-F41, Atlanta, GA 30341, USA; (email: nba7@cdc.gov).
(In Public Domain. Published by the National Rural Health Association)
Computerized mortality data files from the National Center for Health Statistics were analyzed to describe childhood farm drowning from 1986 through 1997. Farm drowning rates were compared to the U.S. unintentional youth drowning rates for the same period. The denominator for the calculation of rates was derived from a series of farm youth estimates published by the Bureau of Census. There were 378 childhood farm drowning cases during the study period, for an average annual rate of 2.3 deaths per 100,000 farm youth resident years. This rate is comparable to unintentional drowning rates for U.S. youth (2.2/100,000 population). Fatality rates declined 28% from 1986 through 1997 (p = .0024) for farm youth and 41% for U.S. youth (p = .0001). An average 32 farm drowning incidents occur to youth annually, making drowning a legitimate concern for farm residents and visitors.
A Randomized Controlled Trial of the Middle and Junior High School D.A.R.E. and D.A.R.E. Plus Programs.
- Perry CL, Komro KA, Veblen-Mortenson S, Bosma LM, Farbakhsh K, Munson KA, Stigler MH, Lytle LA. Arch Pediatr Adolesc Med 2003; 157(2): 178-184.
Correspondence: Cheryl L. Perry, Division of Epidemiology, School of Public Health, University of Minnesota, 1300 S Second St, Suite 300, Minneapolis, MN 55454, USA; (email: perry@epi.umn.edu).
OBJECTIVE: To evaluate the effect of the middle and junior high school Drug Abuse Resistance Education (D.A.R.E.) and D.A.R.E. Plus programs on drug use and violence. DESIGN: Randomized controlled trial of 24 schools, with 3 conditions: D.A.R.E. only, D.A.R.E. Plus, and delayed program control.
SETTINGS: Schools and neighborhoods, primarily in Minneapolis-St Paul.
PARTICIPANTS: All seventh-grade students in 24 schools in the academic year 1999-2000 (N = 6237 at baseline, 67.3% were white, and there was 84.0% retention at final follow-up).
INTERVENTIONS: The middle and junior high school D.A.R.E. curriculum in the 16 schools that received D.A.R.E. only and D.A.R.E. Plus. In the 8 schools that received D.A.R.E. Plus, additional components included a peer-led parental involvement classroom program called "On the VERGE," youth-led extracurricular activities, community adult action teams, and postcard mailings to parents. The interventions were implemented during 2 school years, when the cohort was in the seventh and eighth grades.
MAIN OUTCOME MEASURES: Self-reported tobacco, alcohol, and marijuana use; multidrug use; violence; and victimization, assessed at the beginning and end of seventh grade and at the end of eighth grade. Growth curve analytic methods were used to assess changes over time by condition.
FINDINGS: There were no significant differences between D.A.R.E. only and the controls; significant differences among boys between D.A.R.E. Plus and controls for tobacco, alcohol, and multidrug use and victimization; significant differences among boys between D.A.R.E. Plus and D.A.R.E. only in tobacco use and violence; and no significant behavioral differences among girls.
DISCUSSION: D.A.R.E. Plus significantly enhanced the effectiveness of the D.A.R.E. curriculum among boys and was more effective than the delayed program controls, underscoring the potential for multiyear, multicomponent prevention programs and demonstrating sex differences in response to intervention programs.
Correspondence: Hatice Demirbas, Alcohol and Substance Abuse Treatment Unit, Ankara University Faculty of Medicine, Ankara, TURKEY; (email: unavailable).
OBJECTIVES: This study evaluated correlations of self esteem, depression, and state-trait anxiety with suicide probability in alcohol dependence.
METHODS: The sample consists of 70 patients who were hospitalized in the Alcohol and Substance Abuse Treatment Unit in the Psychiatry Clinic of Ankara University between the years 1999 and 2000. Patients' histories, the Suicide Probability Scale, the Coopersmith Self-Esteem Inventory, the Beck Depression Inventory and the Spielberger State-Trait Anxiety Scales were used. Correlation, linear regression and t-test statistical analyses were performed.
FINDINGS: It was found that self-esteem, depression and trait anxiety predict suicide probability. Suicide probability was higher within the sub-sample with a history of a suicidal act in comparison to those without such a history.
Influence of cohort effects on patterns of suicide in England and Wales, 1950-1999.
- Gunnell D, Middleton N, Whitley E, Dorling D, Frankel S. Br J Psychiatry 2003;182: 164-170.
Correspondence: David Gunnell, Department of Social Medicine, University of Bristol. School of Geography, University of Leeds. Department of Social Medicine, University of Bristol, UK; (email: D.J.Gunnell@Bristol.ac.uk).
Background Age- and gender-specific suicide rates in England and Wales have changed considerably since 1950. Aims To assess whether cohort effects underlie some of these changes. Method Graphical displays to assess age-period-cohort effects on suicide for the period 1950-1999. Results Successive male birth cohorts born after 1940 carried with them, as they aged, a greater risk of suicide than their predecessors although this effect diminished for the 1975 and 1980 birth cohorts. There was less clear evidence of any increased risk of suicide in post-war female birth cohorts. Conclusions Succeeding generations of males born in the post-war years have experienced increasing rates of suicide at all ages, an observation in keeping with patterns seen in other countries. If these trends continue into middle- and old-age they will lead to a great increase in overall male suicide rates.
Evidence that cell phone use while driving increases the risk of being involved in a motor vehicle crash has led policymakers to consider prohibitions on this practice. However, while restrictions would reduce property loss, injuries, and fatalities, consumers would lose the convenience of using these devices while driving. Quantifying the risks and benefits associated with cell phone use while driving is complicated by substantial uncertainty in the estimates of several important inputs, including the extent to which cell phone use increases a driver's risk of being involved in a crash, the amount of time drivers spend using cell phones (and hence their aggregate contribution to crashes, injuries, and fatalities), and the incremental value to users of being able to make calls while driving. Two prominent studies that have investigated cell phone use while driving have concluded that the practice should not be banned. One finds that the benefits of calls made while driving substantially exceed their costs while the other finds that other interventions could reduce motor vehicle injuries and fatalities (measured in terms of quality adjusted life years) at a lower cost. Another issue is that cell phone use imposes increased (involuntary) risks on other roadway users. This article revises the assumptions used in the two previous analyses to make them consistent and updates them using recent data. The result is a best estimate of zero for the net benefit of cell phone use while driving, a finding that differs substantially from the previous study. Our revised cost-effectiveness estimate for cell phone use while driving moves in the other direction, finding that the cost per quality adjusted life year increases modestly compared to the previous estimate. Both estimates are very uncertain.
This paper describes some of the main findings from two separate studies on accident prediction models for urban junctions and urban road links. The main objective for the studies was to establish simple, practicable accident models that can predict the expected number of accidents at urban junctions and road links as accurately as possible. The models can be used to identify factors affecting road safety and in relation to 'black spot' identification and network safety analysis undertaken by local road authorities. The accident prediction models are based on data from 1036 junctions and 142km road links in urban areas. Generalized linear modeling techniques were used to relate accident frequencies to explanatory variables. The estimated accident prediction models for road links were capable of describing more than 60% of the systematic variation ('percentage-explained' value) while the models for junctions had lower values. This indicates that modeling accidents for road links is less complicated than for junctions, probably due to a more uniform accident pattern and a simpler traffic flow exposure or due to lack of adequate explanatory variables for junctions. Explanatory variables describing road design and road geometry proved to be significant for road link models but less important in junction models. The most powerful variable for all models was motor vehicle traffic flow.
An on-road study to investigate fatigue in local/short haul trucking.
Correspondence: Richard J. Hanowski, Virginia Tech Transportation Institute, 3500 Transportation Research Plaza, 24061, Blacksburg, VA, USA; (email: hanowski@vtti.vt.edu).
As a precursor to the present research, Hanowski et al. [FHWA Report no. FHWA-MC-98-029. Office of Motor Carriers, Federal Highway Administration, Washington, DC, 1998] conducted a series of focus groups in which local/short haul (L/SH) drivers provided their perspective on safety issues, including fatigue, in their industry. As a follow-up to the Hanowski et al. work, the effort presented here consisted of an on-road field study where in-service L/SH trucks were instrumented with data collection equipment. Two L/SH trucking companies and 42 L/SH drivers participated in this research. The analyses focused on determining if fatigue is an issue in L/SH operations. Of primary interest were critical incidents (near-crashes) where L/SH drivers were judged to be at fault. The results of the analyses indicated that fatigue was present immediately prior to driver involvement in at-fault critical incidents. Though it is difficult to determine with certainty why fatigue was present, the results suggest that drivers' off-hours behavior likely played a significant role in the fatigue experienced on the job. Another key finding of this research is that a small percentage of drivers were responsible for a majority of the critical incidents. This finding suggests that driver selection and monitoring could potentially improve safety in L/SH operations.
Headway feedback improves inter-vehicular distance: a field study.
- Shinar D, Schechtman E. Hum Factors 2002; 474-481.
Correspondence: David Shinar, Ben Gurion University of the Negev, Beer Sheva, ISRAEL. (email: shinar@bgumail.bgu.ac.il).
The effectiveness of a headway measuring and recording device was evaluated in terms of its ability to increase drivers' car-following distance. Forty-three drivers first drove for approximately 3 weeks without headway feedback and then for approximately 3 more weeks with immediate time headway (THW) feedback. Whenever the THW decreased to 1.2 s or less a red warning light came on, and whenever the THW decreased further to 0.8 s or less a buzzer was also sounded. The results showed that prior to receiving THW information,drivers drove at shorter headways than after they received that information. The effect of the feedback was to reduce the time spent in short headways (<or = 0.8 s) by approximately 25% (from 20% to 15% of the time) and to increase the time spent in safer longer headways (>1.2 s) by approximately 20% (from 57% to 65% of the time). The effect was similar for younger and older drivers, for male and female drivers, for urban and highway speeds, and for daytime and nighttime driving. An immediate application of these findings is to install headway feedback displays to drivers so that they may maintain safer headway distances than they do currently.
Correspondence: T. Field, Touch Research Institutes, University of Miami School of Medicine, Department of Pediatrics (D-820), P.O. Box 016820, Miami, Florida 33101, USA; (email: tfield@med.miami.edu).
The increasing incidence of violence among children and adolescents highlights the importance of identifying at-risk profiles as well as assessing interventions for preventing violence. Empirical research has suggested behavioral, central nervous system, and neurotransmitter/neurohormone dysregulation in violent individuals, including (1) an underaroused central nervous system characterized by right frontal electroencephalogram (EEG) hypoactivation, and (2) a neurotransmitter/neurohormone profile of lower norepinephrine, serotonin, and cortisol, and elevated dopamine and testosterone. The literature also suggests a disproportionate incidence of physical abuse and neglect or the lack of positive physical contact in violent individuals. In the studies we have conducted to date, there has been a relatively high incidence of anger and aggression in high school samples, even those that were relatively advantaged, as well as high levels of depression (one standard deviation above the mean), suggesting significant disturbance in these youth. Adolescents with these profiles also had less optimal relationships with their families, used illicit drugs more frequently, had inferior academic performance, and had higher depression scores. In our cross-cultural comparisons, preschoolers and adolescents were less physically affectionate and more aggressive in the United States versus France. Further, the U.S. youth received less physical affection as preschoolers, and as adolescents they engaged in more self-stimulating behaviors, perhaps to compensate for receiving less physical affection from their parents and peers. This supports the notion that less physical affection (or more physical neglect) can contribute to greater aggression. Massage therapy has been effective with violent adolescents, perhaps because the physical stimulation reduced their dopamine levels and increased their serotonin levels. Their aggressive behavior decreased and their empathetic behavior increased. These preliminary data need to be replicated in a larger sample with a more comprehensive set of measures in the context of identifying a diagnostic profile.
Primary Mental Health Workers within Youth Offending Teams: a new service model.
- Callaghan J, Pace F, Young B, Vostanis P. J Adolesc 2003; 26(2): 185-199.
Correspondence: Panos, Vostanis, Division of Child and Adolescent Psychiatry, University of Leicester, UK; (email: pv11@le.ac.uk).
Primary Mental Health Workers (PMHWs) have been deployed to address the mental health needs of young offenders referred to Youth Offending Teams (YOTs) in two UK areas. The mental health characteristics of 60 young people consecutively referred to these PMHWs, the assessment outcome and interventions offered, are described. In addition to the anticipated concerns about oppositional/aggressive behavior, young people were referred for a range of mental health problems. There were high levels of emotional problems, self-harm, peer and family relationships difficulties, and school non-attendance. PMHWs offered a range of direct interventions, as well as consultation to YOT staff. The service findings indicate the usefulness of such an inter-agency model in strengthening the links between specialist CAMHS and YOTs, and providing an accessible, responsive and effective service to a needy group of young people.
Victims of domestic violence on the trauma service: unrecognized and underreported.
- Davis JW, Parks SN, Kaups KL, Bennink LD, Bilello JF. J Trauma 2003; 54(2): 352-5.
Correspondence: James W. Davis, MD, FACS, Department of Surgery, University Medical Center, 445 South Cedar Avenue, Fresno, CA 93702, USA; (email:unavailable).
BACKGROUND: Domestic violence (DV) has received increased recognition as a significant mechanism of injury. To improve awareness about DV at our institution, an educational program was presented to the departments of surgery and emergency medicine. Pre and posttests were given and improvement in knowledge was demonstrated. In addition, a screening question for DV was added to the trauma history and physical (H & P) form. This study was done to determine the long-term efficacy of these efforts in increasing recognition of DV and referral to social services in patients admitted to the trauma service. Recognition of DV and appropriate referral should be increased after education and change in H & P form.
METHODS: All patients admitted to the trauma service at a Level I trauma center over a 10 month period with the mechanism of injury "assault" were reviewed. DV was determined to be present, likely, unknown, or absent based on information from the prehospital report and medical records. The DV screen question was reviewed for use and accuracy.
FINDINGS: During the study period, 1,550 patients were admitted to the trauma service, with assault listed as the mechanism of injury for 217 (14%). DV was confirmed or likely in 27 patients (12.4% of the assaults). Of patients with confirmed or likely DV, only 7 received appropriate referrals, with 2 generated by the nursing staff. Of the confirmed and likely DV patients, 17 (63%) were sent home without investigation of safety and only 21% of all assault victims had any social services evaluation (usually to investigate funding or placement). The DV screen was used in only 12 patients. Reasons given for failure to complete the DV screen on the H & P included examiner discomfort in asking the question, and an environment judged to be inappropriate (resuscitation area in the emergency department).
DISCUSSION: DV is unrecognized and underreported. Efforts to improve recognition and reporting of DV events need to be ongoing. Screening for DV is not effectively done as part of the initial evaluation. Assessment for DV may be more appropriate as part of the tertiary survey.
Interventions for intimate partner violence against women: clinical applications.
- Rhodes KV, Levinson W. JAMA 2003; 289(5): 601-5.
Correspondence: K Rhodes, Section of Emergency Medicine, Department of Medicine, The University of Chicago, 5841 S Maryland Ave, MC 5068, Chicago, IL 60637, USA; (email: krhodes@medicine.bsd.uchicago.edu).
Sufficient evidence regarding the effectiveness of physician screening, counseling, and referral for intimate partner violence is lacking. However, even in the absence of sufficient evidence, many medical organizations recommend that physicians make efforts to identify and refer patients who have experienced abuse. This article presents 3 cases that illustrate the interaction between patients experiencing violence in intimate relationships and physicians and other members of the health care team. Suggestions for care are based on guidelines and evidence where available. Resources to assist physicians with referral to appropriate services also are provided.
Interventions for violence against women: scientific review.
Correspondence: C Wathen, Canadian Task Force on Preventive Health Care, 100 Collip Circle, Suite 117, London, Ontario N6G 4X8, CANADA; (email: cwathen@uwo.ca).
BACKGROUND: Intimate partner violence is prevalent and is associated with significant impairment, yet it remains unclear which interventions, if any, reduce rates of abuse and reabuse.
OBJECTIVE: To systematically review, from the perspective of primary health care, the available evidence on interventions aimed at preventing abuse or reabuse of women.
DATA SOURCES: MEDLINE, PsycINFO, CINAHL, HealthStar, and Sociological Abstracts were searched from the database start dates to March 2001 using database-specific key words such as domestic violence, spouse abuse, partner abuse, shelters, and battered women. References of key articles were hand searched. The search was updated in December 2002.
STUDY SELECTION: Both authors reviewed all titles and abstracts using established inclusion/exclusion criteria. Twenty-two articles met the inclusion criteria for critical appraisal.
DATA EXTRACTION: Following the evidence-based methods of the Canadian Task Force on Preventive Health Care, both authors independently reviewed the 22 included studies using an established hierarchy of study designs and criteria for rating internal validity. Quality ratings of individual studies-good, fair, or poor-were determined based on a set of operational parameters specific to each design category developed with the US Preventive Services Task Force.
DATA SYNTHESIS: Screening instruments exist that can identify women who are experiencing intimate partner violence. No study has examined, in a comparative design, the effectiveness of screening when the end point is improved outcomes for women (as opposed to identification of abuse). No high-quality evidence exists to evaluate the effectiveness of shelter stays to reduce violence. Among women who have spent at least 1 night in a shelter, there is fair evidence that those who received a specific program of advocacy and counseling services reported a decreased rate of reabuse and an improved quality of life. The benefits of several other intervention strategies in treating both women and men are unclear, primarily because of a lack of suitably designed research measuring appropriate outcomes. In most cases, the potential harms of interventions are not assessed within the studies reviewed.
DISCUSSIONS: Much has been learned in recent years about the epidemiology of violence against women, yet information about evidence-based approaches in the primary care setting for preventing intimate partner violence is seriously lacking. The evaluation of interventions to improve the health and well-being of abused women remains a key research priority.
Violent victimization of women and men: physical and psychiatric symptoms.
- Porcerelli JH, Cogan R, West PP, Rose EA, Lambrecht D, Wilson KE, Severson RK, Karana D. J Am Board Fam Pract 2003; 16(1): 32-39.
Correspondence: John H. Porcerelli, Department of Family Medicine, Wayne State University School of Medicine, Detroit, MI 48235, USA; (email: jporcer@wayne.edu).
BACKGROUND: Our objectives for this exploratory study were (1) to assess the prevalence in a family practice of violent victimization of women and men by partners, friends, families, and strangers, and (2) to compare the physical symptoms, depression, alcohol use problems, and social support of women and men who were or were not victimized in the previous 12 months.
METHODS: We conducted a cross-sectional, multicenter study of family practice patients (1999-2000). One-thousand twenty-four patients, including 679 women and 345 men from 18 to 64 years of age completed a standard health history and a demographic questionnaire. The health history questionnaire included a question about violent victimization.
FINDINGS: Violent victimization was reported by 9.9% of the women and 10.9% of the men. Patients who were victimized were grouped into those who were victimized by partners (4.9% of women and 3.0% of men); by friends, or family, or strangers (2.3% of women and 5.0% of men); or by more than one category of persons other than partners (2.6% of women and 3.0% of men). Almost one third of patients victimized by partners were also victimized by another person. Women who were victimized had more physical symptoms than women who were not victimized. Women who were victimized and men who were victimized by their partners had more depressive symptoms than other women and men. Patients who were victimized by more than one category of other victimizers reported more alcohol use problems than other patients. Patients who were victimized reported less social support than patients who were not victimized.
DISCUSSION: Both women and men report violent victimization in response to a screening question. Violence by partners and by others is related to physical and psychiatric symptoms in women and in men.
